Individual
JENELLE CECILIA ROCK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
1950 NORTHWESTERN AVE S, SUITE 102, STILLWATER, MN 55082-7590
(651) 430-3800
(651) 430-3827
Mailing address
1950 NORTHWESTERN AVE S, STE 102, STILLWATER, MN 55082-7615
(651) 430-3800
(651) 430-3827
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
12053
MN
363AS0400X
Surgical Physician Assistant
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
47061995513
—
NE
Enumeration date
01/13/2009
Last updated
11/13/2020
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